essa experiences
Reflections and ruminations on life in an emergency social work service.
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Lindsay Blase is a social worker in the Emergency Dept. at Stepping Hill Hospital,
Stockport, officially part of the out of hours team for social services, and works alone.
The following is an account of a typical day.
Another mad day in the Emergency Department
I arrived at 14.33, checked in at the nurses’ station re state of play and any
referrals. Got into my room to find a referral faxed through from this morning, re
a well known attender (53) with alcohol problems. Had (?) fallen, mobility
decreased, Physio and occupational therapist suggesting intermediate care, only
trouble is, she’s the wrong age group and I don’t think a nursing home bed is
appropriate. Discussed with colleague.
Contacted by admissions unit staff, approximately 14.50 re Mrs. G. (87), a
patient referred yesterday, admitted from outside Stockport. Owing to reduced
mobility and her own social services’ reluctance to arrange respite care, the plan
had been to transfer her to the cottage hospital in her own area. She wasn’t
sent, ward now saying she doesn’t need it. Now mobile, can go home, need to
liaise with social services. Already spoken to care worker yesterday. Spoke to
patient about help needed. We decided that am and evening calls for help and
supervision with bed transfers were required, probably on a temporary basis.
Rang care worker re change of plans, persuaded her to look for input as
assessed, she went off to see what she could do.
Told the ward that I couldn’t sort 53 year old, and why. Had discovered that
she has an area social worker, rang her re events, mobility, history and concerns.
She was unaware re admission, very surprised patient drinking again. Social
worker not concerned re current state, feels we can send her home and she will
revert to her usual level of mobility and independence. Said she would check re
extra homecare input over the weekend, couldn’t be certain she would be able to
arrange it (it’s Thursday) said we might have to keep till Monday! Told her this is
not really an option. Social worker appears to feel we don’t know s/u like she
does.
She rang back later to say that a lunch call was already in situ for tomorrow,
so get her home by 12.00, with a daily call arranged for over the weekend. Also
wanting a commode sent home with her. Told her we could use the private
ambulance to get her home on time, and I can provide a commode. Wants us to
ask the ambulance crew to put the commode by the side of the armchair she
uses. Gave me the keysafe number, although she thinks the door might not be
locked! Also wants the pts crew to put any booze they might find into the fridge!
Told her that wasn’t in their remit. She doesn’t appear to have a high opinion of
pts staff.
Contacted by Dan, Social Worker, 15.15, re a terminally ill patient being sent
to the emergency dept. A victim of abuse, there’s a probable bed in a long stay
ward, via the medical consultant, if needed. Informed staff on admissions unit,
wrote details in the medical notes as client referred to medics. (Might save them
a bed if client’s condition is stable.)
Contacted (15.30) by the daughter of the first adult protection patient (87)
referred earlier this week. Daughter’s been away, wanting an update re the
referral and the investigation. Didn’t tell her it’s still unclear who’s going to do it.
Previous complaints and issues discussed. Later, emailed details of this
conversation to several team leaders and an adult practitioner.
Whilst still on EAU, checked whereabouts of a cancer patient (66) seen
yesterday re services, again from outside Stockport. Moved to another ward
today. Checked later with the ward, no discharge date, to have radiotherapy.
Bleeped by fracture clinic, 16.23 re patient (73) with a ruptured Achilles
tendon on one side, and effects of an old stroke on the other. Saw patient, not
happy with his leg in plaster, wants it taken off. Can’t mobilise with it on. Can’t
understand why, when he’s been walking on it for 3 weeks, and driving, he can’t
continue to do so. He ended up being surrounded by nurse, doctor, plaster
technician, son and myself reasoning with him. Eventually agreed to be
admitted, pending a change to a boot, with occupational therapist and
physiotherapist assessment. Told him I’d review the situation tomorrow.
17.55. Patient, (83) with back pain referred by staff nurse, emergency
department. Found to have an old fracture; I suggested move to admissions unit
overnight, for assessment by occupational therapist and physiotherapist am, I will
review tomorrow.
Contacted by staff nurse, emergency department at 18.00 re concerns about
a residential home resident, admitted with what turns out to be an arm fracture.
Issues re lack of information from the home, re transport arrangements to
emergency department, late presentation. Agreed with nurse that she would
complete a cause for concern referral.
Contacted 18.30 by daughter of the second adult protection referral (85) from
Monday, wanting to discuss the way forward. Not sure now whether her mother
should return to the home. Other issues raised, I suggested assessment re ?
continuing health care, to which she agreed. Ward staff informed, details in
notes, ward to refer.
18.40, patient (87) referred re recurrent falls, left leg injury, right foot slipping
when mobilising, very little feeling in lower legs, partially sighted. All these health
problems reported a bit at a time, increasing my gloom re assessment. Went
round to see the patient; doctor had decided to admit for MDT, as issues re safety
at home prior to admission, mobility on stairs. Told staff I will see patient
tomorrow, after occupational therapist and physiotherapist assessment.
Spoke to 53 year old re plans, she said she might feel well enough to go
home tomorrow, might not. Emailed social worker later, asking her to check with
the ward in the morning re discharge. Reminded ward re commode, ambulance
etc. Whilst on admissions unit, referral timed19.35, from a home help via the out of
hours team, trying to trace a patient and his wife in the emergency department.
No record of him in the department or on the hospital computer. After several
phone calls, found that the home help had spelt his name wrong. Patient traced
to a ward, wife located at home, carers sent round to her.
Spent rest of evening in my room, putting observations and assessments on
screen re all today’s referrals and contacts. Had a request mid evening, 20.22 to
check if a baby in the department is known to social services and ? any issues.
Mother in the department, drunk whilst responsible for looking after the baby.
Previous referrals re alcohol and domestic violence. Staff to complete a cause
for concern referral. Baby safe with a relative. Informed out of hours team, gave
details, put them through to the nurses’ station.
Finally finished at 22.45, supposed to finish at 22.00. had warned my
husband at 18.30 that I knew I would be late, because of the need to record
everything. On going out via the nurses’ station, I was asked by the registrar on
duty if I had a spare key to his room. He’s due to finish at midnight and another
doctor has locked the door, with his keys inside and gone home. Registrar can’t
get home. Told him no, no-one else has a key, suggested he get security to
break in.
Then asked by staff nurse if I would be happy for a patient (70’s) to go home.
Came in after a dizzy spell when he stood up. Nothing since, and he wants to go
home. Clarified not drunk, is mobile, nurse concerned because his colostomy
bag has overflowed, faeces on his clothes and his washing machine isn’t
working. Suggested she refer him to hospital aftercare scheme run by age
concern, for follow up. She decided to refer him to age concern. I rang for a taxi
and went home.
home | regional contacts | documentation | vacancies | conferences | essa experiences | news log
Lindsay Blase is a social worker in the Emergency Dept. at Stepping Hill Hospital,
Stockport, officially part of the out of hours team for social services, and works alone.
The following is an account of a typical day.
Another mad day in the Emergency Department
I arrived at 14.33, checked in at the nurses’ station re state of play and any
referrals. Got into my room to find a referral faxed through from this morning, re
a well known attender (53) with alcohol problems. Had (?) fallen, mobility
decreased, Physio and occupational therapist suggesting intermediate care, only
trouble is, she’s the wrong age group and I don’t think a nursing home bed is
appropriate. Discussed with colleague.
Contacted by admissions unit staff, approximately 14.50 re Mrs. G. (87), a
patient referred yesterday, admitted from outside Stockport. Owing to reduced
mobility and her own social services’ reluctance to arrange respite care, the plan
had been to transfer her to the cottage hospital in her own area. She wasn’t
sent, ward now saying she doesn’t need it. Now mobile, can go home, need to
liaise with social services. Already spoken to care worker yesterday. Spoke to
patient about help needed. We decided that am and evening calls for help and
supervision with bed transfers were required, probably on a temporary basis.
Rang care worker re change of plans, persuaded her to look for input as
assessed, she went off to see what she could do.
Told the ward that I couldn’t sort 53 year old, and why. Had discovered that
she has an area social worker, rang her re events, mobility, history and concerns.
She was unaware re admission, very surprised patient drinking again. Social
worker not concerned re current state, feels we can send her home and she will
revert to her usual level of mobility and independence. Said she would check re
extra homecare input over the weekend, couldn’t be certain she would be able to
arrange it (it’s Thursday) said we might have to keep till Monday! Told her this is
not really an option. Social worker appears to feel we don’t know s/u like she
does.
She rang back later to say that a lunch call was already in situ for tomorrow,
so get her home by 12.00, with a daily call arranged for over the weekend. Also
wanting a commode sent home with her. Told her we could use the private
ambulance to get her home on time, and I can provide a commode. Wants us to
ask the ambulance crew to put the commode by the side of the armchair she
uses. Gave me the keysafe number, although she thinks the door might not be
locked! Also wants the pts crew to put any booze they might find into the fridge!
Told her that wasn’t in their remit. She doesn’t appear to have a high opinion of
pts staff.
Contacted by Dan, Social Worker, 15.15, re a terminally ill patient being sent
to the emergency dept. A victim of abuse, there’s a probable bed in a long stay
ward, via the medical consultant, if needed. Informed staff on admissions unit,
wrote details in the medical notes as client referred to medics. (Might save them
a bed if client’s condition is stable.)
Contacted (15.30) by the daughter of the first adult protection patient (87)
referred earlier this week. Daughter’s been away, wanting an update re the
referral and the investigation. Didn’t tell her it’s still unclear who’s going to do it.
Previous complaints and issues discussed. Later, emailed details of this
conversation to several team leaders and an adult practitioner.
Whilst still on EAU, checked whereabouts of a cancer patient (66) seen
yesterday re services, again from outside Stockport. Moved to another ward
today. Checked later with the ward, no discharge date, to have radiotherapy.
Bleeped by fracture clinic, 16.23 re patient (73) with a ruptured Achilles
tendon on one side, and effects of an old stroke on the other. Saw patient, not
happy with his leg in plaster, wants it taken off. Can’t mobilise with it on. Can’t
understand why, when he’s been walking on it for 3 weeks, and driving, he can’t
continue to do so. He ended up being surrounded by nurse, doctor, plaster
technician, son and myself reasoning with him. Eventually agreed to be
admitted, pending a change to a boot, with occupational therapist and
physiotherapist assessment. Told him I’d review the situation tomorrow.
17.55. Patient, (83) with back pain referred by staff nurse, emergency
department. Found to have an old fracture; I suggested move to admissions unit
overnight, for assessment by occupational therapist and physiotherapist am, I will
review tomorrow.
Contacted by staff nurse, emergency department at 18.00 re concerns about
a residential home resident, admitted with what turns out to be an arm fracture.
Issues re lack of information from the home, re transport arrangements to
emergency department, late presentation. Agreed with nurse that she would
complete a cause for concern referral.
Contacted 18.30 by daughter of the second adult protection referral (85) from
Monday, wanting to discuss the way forward. Not sure now whether her mother
should return to the home. Other issues raised, I suggested assessment re ?
continuing health care, to which she agreed. Ward staff informed, details in
notes, ward to refer.
18.40, patient (87) referred re recurrent falls, left leg injury, right foot slipping
when mobilising, very little feeling in lower legs, partially sighted. All these health
problems reported a bit at a time, increasing my gloom re assessment. Went
round to see the patient; doctor had decided to admit for MDT, as issues re safety
at home prior to admission, mobility on stairs. Told staff I will see patient
tomorrow, after occupational therapist and physiotherapist assessment.
Spoke to 53 year old re plans, she said she might feel well enough to go
home tomorrow, might not. Emailed social worker later, asking her to check with
the ward in the morning re discharge. Reminded ward re commode, ambulance
etc. Whilst on admissions unit, referral timed19.35, from a home help via the out of
hours team, trying to trace a patient and his wife in the emergency department.
No record of him in the department or on the hospital computer. After several
phone calls, found that the home help had spelt his name wrong. Patient traced
to a ward, wife located at home, carers sent round to her.
Spent rest of evening in my room, putting observations and assessments on
screen re all today’s referrals and contacts. Had a request mid evening, 20.22 to
check if a baby in the department is known to social services and ? any issues.
Mother in the department, drunk whilst responsible for looking after the baby.
Previous referrals re alcohol and domestic violence. Staff to complete a cause
for concern referral. Baby safe with a relative. Informed out of hours team, gave
details, put them through to the nurses’ station.
Finally finished at 22.45, supposed to finish at 22.00. had warned my
husband at 18.30 that I knew I would be late, because of the need to record
everything. On going out via the nurses’ station, I was asked by the registrar on
duty if I had a spare key to his room. He’s due to finish at midnight and another
doctor has locked the door, with his keys inside and gone home. Registrar can’t
get home. Told him no, no-one else has a key, suggested he get security to
break in.
Then asked by staff nurse if I would be happy for a patient (70’s) to go home.
Came in after a dizzy spell when he stood up. Nothing since, and he wants to go
home. Clarified not drunk, is mobile, nurse concerned because his colostomy
bag has overflowed, faeces on his clothes and his washing machine isn’t
working. Suggested she refer him to hospital aftercare scheme run by age
concern, for follow up. She decided to refer him to age concern. I rang for a taxi
and went home.